Organization
SOUTHWEST ELECTRODIAGNOSTIC CENTER LLC
Active
Organization
SOUTHWEST ELECTRODIAGNOSTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY G RAROQUE JR. MD (MANAGER)
(866) 620-5987
Entity
Organization
Contact information
Practice address
16135 PRESTON RD STE 135, BOX 21, DALLAS, TX 75248-3590
(866) 620-5987
Mailing address
PO BOX 794564, DALLAS, TX 75379-4564
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
H6748
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H6748
LICENSE
TX
Enumeration date
05/10/2012
Last updated
05/10/2012
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